Tuesday, September 15, 2015

Maine: The opiate issue (2/2)

Welcome back to the Portland Maine area. This is article #2 on the opiate addiction issue - if you have not read article #1 please do. You can access it by Clicking Here.

Yesterday we talked to paramedics, police officers, emergency room staff and detox personnel. Today we will try to find out what the precious few who break this addiction are doing different than all the rest.

We start with a man who has for twelve years in the long term rehab arena. And I say arena - it really is a fight for these men.

New Destiny Treatment Center

Brent worked at a facility that takes in male addicts and alcoholics for a period of nine months. In the twelve years that Brent worked here he has seen over 2,000 men come through - many of them more than once. Over that time he has had occasion to see what works and what doesn't work.

Brent and his dog Conan

One of the approaches taken with opiate addicts is to give them drugs that keep them from going into withdrawals. The two most commonly used are Methadone and Suboxone.

Opiate withdrawals are so severe that an addict is incapacitated for at least a couple of weeks, if not months. These drugs delay the withdrawals and hopefully allow an addict to step down the dosage over time, allowing them to continue functioning in their environment.

There are a few who follow this regimen and are able to reduce the dosages and ultimately get off the opiates entirely. But the vast majority just get stuck in another cycle. They use these drugs until they can put some resources back to together then return to whatever opiate they can get their hands on. They once again burn all resources and bridges until the next time circumstances come back around and forces them to face the prospect of withdrawals. It is a brutal cycle, and to the addict it truly appears that death is the only way out.

These drugs are abused too - the Center for Disease Control says that methadone is involved one way or another in fully a third of overdose fatalities. (source)

Over the years Brent kept track of those that stayed clean. The numbers are dismal. He estimates that about 3% make it five years clean and 1% make it ten years clean. "Addiction doesn't take a day off" says Brent. "Once you are in - you are in. The only people I have seen make it long term are those who rigorously pursue some path of spiritual growth. That may be a 12 step program or it may be a church, but I know of no instance that someone stayed clean without following this path."

Brent ticks off names and causes of death - most of them good decent men in their late teens, twenties and thirties. He ticks off another list - all manner of absurd actions that landed others in prison. 90 percent of the men don't complete anywhere close to the nine months - there always seems to be some urgent reason they have to leave.

Brent talks about the mysterious progressive nature of this issue. It seems that once addicted, the volume of opiate required to satisfy the person's need increases all the time - whether they are using or not. When someone relapses after some clean time their addiction is immediately worse than it was before they quit.

"One thing for sure" says Brent. "Whatever a recovering addict places more importance on than their recovery they are going to lose - along with whatever clean time they have. Recovery has to be their first and foremost priority - all day every day for the rest of their lives."

All of the people in the treatment arena I spoke with talked about a losing battle. They see almost no success rate for recovery but a non stop surge in new addicts. The only long term solution they see is to halt the increase of new addicts. Very few of those that are addicted will make it out.

As for the pool of addicts - the CDC says that in the US there are 2.1 million pharmaceutical opiate addicts. These are the folks who have never used heroin. There are another 460,000 opiate addicts who have used heroin in addition to pharmaceutical drugs. (source) So fully 80% of opiate users have not crossed the line to using heroin in hypodermic needles. But these numbers bring up an important point: If we could nudge the percentage of those who recover from 1% up to 10% we are talking about hundreds of thousands of lives.

There is one group who seems to have had more success in the recovery arena than any other I have found. This is a unique nationwide system of long term recovery houses called Oxford House.

Oxford Houses were bred of necessity back in 1975. A man named Paul Malloy was very successful in the national political scene - in fact he wrote the original Amtrak bill that passed congress. But he had a problem with drinking and ended up losing his job, his home and his family.

Paul got sober and was living in a halfway house - making a comeback. But the halfway house announced they were closing. Paul was terrified that he would not be able to stay sober. So Paul and his housemates negotiated with the landlord to keep paying the rent. They also set up something that has saved tens of thousands of men and women's houses - a system of "government" that allows a house full of newly sober addicts and alcoholics to run their own house.

File photo from 60 minutes interview

Today there are over 1900 Oxford Houses nationwide. These provide over 15,000 beds - over 4,000 of those are for women. The organization is loosely run - the national office gives a charter to folks that want to open a new house and provides them with logistical support.

The national office only has three rules for any house to operate under their name. 1. No drinking or drugging. 2 Bills have to be paid on time. 3. No disruptive behavior.

From that point each house sets its own rules - in democratic votes. House members interview prospective new residents and then vote if they will allow that person in. Usually houses have a rule that an 80% affirmative vote is required to allow a person in, but votes on all other house matters are decided by a simple majority.

Individual rent seems to average $110 per resident per week. Out of this the rent, all utilities, cleaning supplies, toiletries and basic kitchen items are supplied by the house. Kitchens are fully furnished, and residents are responsible for their own cooking.

Houses are in middle class neighborhoods - the theory being that you have to get the addict out of bad neighborhoods if they are going to have a decent chance. Usually someone has to have 30 days clean for a house to consider taking them in. Rehab centers and word of mouth are the sources of new clients. The average house has 6 to 8 members, but some of the bigger houses like the one pictured above can have as many as 12 or 15.

Most houses have recovery program requirements - a new member may be required to attend 90 Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meetings in their first 90 days in the house. After they the average requirement is 3 meetings a week.

There are house officers, and terms are limited to three or six months so no one gains "power" in a house. There is a president, usually someone who has been in the house a year or more, who chairs the weekly meetings and is responsible for major house affairs like dealing with the landlord, calling emergency meetings, administering drugs tests and evicting residents who don't follow the rules. Any house member can request that any other house member be drug tested at any time, and there is a random drug test of a name pulled from a hat at the weekly house meetings. If someone relapses they have 30 minutes to pack their things and be out.

Everyone shares chores on a rotating chore list, and every room gets cleaned at least twice a week. The kitchen chore is the hardest - it gets cleaned daily. One of the house members is elected "Chore Coordinator" and is responsible for the rotating list and for imposing monetary fines for those who don't complete their chore. I heard of fines ranging from $10 to $50.

There is also a secretary, responsible for meeting minutes and house correspondence, a treasurer responsible for the checking account and a comptroller who is in charge of collecting rent from the residents.

Once a house starts in a city, residents are motivated to open new houses. Once several houses are open in the same town, the houses form a chapter that has its own government and meets once a week to discuss individual house issues. The current president of the Portland Maine chapter is Cory.

Cory

Cory has two and a half years clean and has served in all of the positions of his individual house and held several offices at the chapter level. "When someone who held office moves out of the house to get back into the mainstream of life, someone else has to step up and fill the role" says Cory. He stepped into the shoes of Chapter President six months ago, and just now after two and a half years clean he feels confident enough to get an apartment again.

Cory has two children, and his wife is now in recovery also. They both play an active role in the children's lives - the children are often at the Oxford House with Cory.

Cory attends AA meetings - he says there is a much greater level of mature sobriety in that program than in the NA program. In AA he finds many people with ten, twenty, even thirty and more years of sobriety. The only requirement for membership in AA is a desire to stop drinking, and since alcohol was also an issue he qualifies to be in the program. He does all the 12 step work in the AA program. When alcohol is being discussed, he realizes it means his opiate addiction as well.

Cory talks about the life skills you learn while working in the various offices of the house and how the men in the house look out for each other. Yes, there are a lot of men who come in and relapse, but there are also a lot who stay sober. He says that in conjunction with his AA program, the fact that the men themselves are in charge of the house and that they hold each other accountable are the main reasons he has been able to stay sober so far.

Jamie, who has 7 months sober is preparing to step in to Cory's shoes as house president. Jamie is building a relationship with the landlord so he can handle issues with the house itself and busily absorbing any wisdom Cory can give him on how to fill the role. And that's how it works - one alcoholic/ addict helping another, holding each other accountable and learning life skills while they grow in sobriety. You can see a sense of pride in the men - few have ever handled checking accounts, collected rent, been involved in a democratic organization or overseen others.

"Jails, Institutions or Death. Those are the only other 3 options for guys like me" says Jamie.

Portland Police Department display case

I have attended several house meetings and talked many hours with a few dozen of the men in the Oxford Houses. EVERY man I talked to is recovering from opiates - just ten years ago the numbers were about fifty percent alcohol, twenty five percent cocaine or benzodiazepines (Valium, etc.) and twenty five percent opiate addicts. Today there are only a couple of people in the 7 Oxford houses that are not opiate addicts.

I asked each man I met how he got started. Every one of them said they got took their first pills in middle school or high school. They all said they felt superior to those that used needles and heroin - but when the demon got too big almost every one of them turned to the cheaper heroin.

To listen to them, it truly sounds like they have a beast in pursuit of them. They say things like "My disease is always doing push-ups, getting stronger all the time. If I don't keep working to improve myself it won't be long at all until it takes me down."

It seems odd to hear something that seems like a choice being called a disease. I am informed that the AMA classified alcoholism and addictions diseases based on four criteria. They are primary - they are not caused by anything else. They are progressive - they always get worse over time. They are chronic - once you get them you are never fully rid of them. And - they are fatal.

Back at Glenda's, we discuss her son Rick, her daughter Stephanie and granddaughter Nichole.

A few months before he died, Rick confided in his mom that his first opiate use was when he was 12 years old. He was at a friends house and they took some pills out of their bathroom cabinet. Rick said that from that day forward the thing he wanted most in life was more of that drug. In the end, it killed him.

Rick was a talented carpenter who had a reputation for quality work. But when his habit grew too large he turned to theft to supplement his income. After being caught several times he was sentenced to a year in the local jail.

While in jail he worked on a job release program at a window manufacturer. While still in jail he was promoted to crew foreman. His probation officer and everyone else was very hopeful - he had been clean a year while in jail and was saying all the right things.

They even let him out of jail for Christmas - he got to spend it with his daughter, now almost two years old.

Two months after this Christmas photo Rick was released from jail. Glenda took him pots and pans and they got furniture so he could have his own apartment. Hope ran high. Two weeks later he was dead of an overdose.

His daughter was in a terrible situation - Rick's ex was an addict also and was turning to doing all the things addicts to to pay for and maintain their addiction - in front of her daughter. Glenda, along with daughter Stephanie (Rick's older sister by two years) intervened and got custody of the daughter. The mother didn't fight: if the strength of addiction is more powerful than our survival instinct it follows that it is much more powerful than our parental instincts.

Topsham, Maine

Glenda took me to a little waterfall where she, Nichole and Stephanie had dumped Rick's ashes. We sat for a long while and talked about his childhood and the lives of the rest of the family. "I had only experienced one thing more painful than giving birth, and that was having to pass a kidney stone" says Glenda. "But the pain of losing a child - that is far greater than either of those."

"Never ever give up on your child" says Glenda. "One day you may not have the option to try to help them anymore."

13 years have passed since Rick died, but the pain still surfaces now and then. But there are odd little things that happen. Rick was always prankster and things are often turning up out of place. Rick knew his mother loves candy, and now and then a pile of candy will mysteriously appear in the corner of the dining room. There have been a number of other odd occurrences - they have just come to expect them.

A few years ago Stephanie got married. The three of them were standing together holding a bouquet of flowers. Out of nowhere and out of season a butterfly landed on the arrangement and sat pulsing its wings. All three looked at each other and burst into tears. Those who are deeply loved are never gone - they reappear in our lives in a multitude of ways.

Today's "Faces in the Crowd" is a young man who was fishing as I was taking sunset photos.

And today's parting shot - after such a heavy topic I couldn't resist a bit of irreverence.

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